Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2003;67(8):1769-1770

What is coronary artery disease?

The vessels that bring blood to the heart are called the coronary arteries. They are like narrow tubes. A fatty substance called plaque (say this: plak) can build up in these arteries and make them narrow, so less blood gets to the heart. This is called coronary artery disease (CAD). If you have CAD, your heart is not getting the blood and oxygen it needs to work like it should. CAD can lead to serious health problems, including angina (pain or pressure in the chest) and heart attack.

Several things increase your risk for CAD, including high blood pressure, smoking, diabetes, obesity, being male, a family history of the disease, and a high cholesterol level. Although you cannot change all of the things that increase your risk for CAD, you can lower your cholesterol level by making changes in your diet (see the box on the next page), and you can quit smoking (if you smoke now).

What is cholesterol?

Cholesterol is a substance that is in all of us. Our bodies make cholesterol. It also is in meat and dairy foods. Plant foods do not have cholesterol. There are several kinds of cholesterol, including low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL cholesterol is called “bad” cholesterol because it can build up on the inside of your arteries, causing them to become narrow. HDL is called “good” cholesterol because it protects your arteries from plaque build-up.

How does lowering LDL cholesterol help?

Lowering your LDL cholesterol level will help keep plaque from building up in your arteries. This makes it easier for your heart to get the blood and nutrients it needs.

If you already have CAD, your doctor will probably want you to lower your LDL level by at least 30 percent through diet, exercise and, possibly, medicines. Another way to help is to increase your HDL level. If you can reduce your LDL level to less than 130 and increase your HDL level to at least 50, you are on the right track.

What foods should I add to my diet?

When you try to lower your LDL cholesterol level, you will want to add foods to your diet that are low in cholesterol and saturated fat, because your body turns saturated fats into cholesterol. A good way to do this is to eat foods that are high in soluble fiber.

There are lots of ways to add healthy foods to your diet. Follow these tips and the serving-size guidelines:

  • Start your day out right. Have some kind of grain (like whole-grain bread or whole-grain cereal) and fruit for breakfast.

  • Think of grains and vegetables as your main dish in lunches and dinners. If you are serving meat or poultry as a main dish, add a tossed salad or a vegetable to your plate.

  • Add beans to leafy green salads, pasta salads, and stews—chick peas, kidney beans, and navy beans have been shown to reduce LDL cholesterol levels.

  • Drink fat-free or 1 percent milk, not whole milk or 2 percent milk. Look for low-fat yogurt and cheese, too.

  • Try soy products. Soy has come a long way in the last few years. Today, you can find soy products in many grocery and health food stores. Try veggie-soy burgers, soy pepperoni, tofu, or soy milk.

  • Serve raw or cooked fruits with low-fat yogurt for dessert.

  • Eat only a little oil. If you want to use oil for cooking, try olive oil or canola oil instead of oils that are high in polyunsaturated fats, such as corn oil, peanut oil, and many margarines. Olive and canola oils are high in monounsaturated fat, which decreases LDL and total cholesterol levels.

  • Eat only small amounts of desserts and candy.

  • Eat one to two servings of fish or seafood each week. People with CAD seem to benefit from eating fish and seafood.

  • Cook with garlic. Several studies have shown that garlic reduces LDL cholesterol levels and lowers blood pressure.

  • Eat moderate amounts of nuts that are rich in monounsaturated fat, like hazelnuts, almonds, pecans, cashews, walnuts, and macadamia nuts. These nuts have been shown to improve cholesterol levels. Avoid eating nuts by the handful. Instead, garnish food with one tablespoon of chopped nuts per person.

Eat less of these foods

  • Potato chips, french fries, and other “junk” foods

  • Vegetables cooked in butter, cheese, or cream sauces

  • Fried foods

  • Whole milk

  • Bacon, sausage, and organ meats (like liver)

  • Egg yolks

  • Cheesecake, pastries, doughnuts, ice cream

  • Butter and margarine

Eat more of these foods

  • Whole-grain breads and pasta, brown rice, whole-grain bagels

  • Fresh, frozen, baked, or steamed fruits and vegetables

  • Steamed, baked, or fresh foods

  • Fat-free milk

  • Fish, skinless poultry, lean cuts of meat (with fat trimmed away), soy products

  • Egg whites, egg substitutes

  • Angel food cake, fig bars, animal crackers, graham crackers, air-popped popcorn, low-fat frozen desserts (yogurt, sherbet, ice milk)

  • Olive oil or canola oil (in small amounts)

What else can I do?

Besides changing your diet, you should talk to your doctor about an exercise program that is right for you. If you smoke, quit. If you are overweight, try to lose weight (changing your diet and exercising will help you lose weight). Talk with your doctor about reducing other risk factors, such as high blood pressure or diabetes.

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